• Raffaele Iorio, Matteo Romano Cantagalli, Edoardo Viglietta, Federico Corsetti, Yuri Gugliotta, Leonardo Previ, Salvatore Gagliardo, Simone Fenucci, and Nicola Maffulli.
• Orthopaedic Unit, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, Rome, Italy.
• Arch Orthop Trauma Surg. 2024 Sep 1; 144 (9): 422542324225-4232.

IntroductionHeterotopic ossifications (HO) are common after total hip arthroplasty (THA). The invasiveness of surgical approaches plays a relevant role in HO development. The aims of this study were to assess the development of HO 6 months after THA through direct lateral approach (DLA) or direct anterior approach (DAA) without a dedicated orthopaedic table and to assess the clinical impact of HO.MethodsThis is a single-center IRB-approved, quasi-randomized prospective cohort, observational imaging study. Fifty patients underwent primary THA through DLA and 50 through DAA. Age, sex, BMI and side of the affected hip were collected. At the 6 post-operative month the Harris Hip Score (HHS) and the presence of HO (scored through the Brooker classification system) were assessed.ResultsThere was no significant difference in the demographic data between groups. Operative time was significantly higher in the DAA group (72 ± 10 min vs. 58 ± 8 min: p < 0.03). At 6 post-operative months the incidence of HO was 14% in the DAA group and 32% in the DLA group (p = 0.02). Severe HO (Brooker 3-4) were significantly more common in the DLA group (p = 0.04). There was no significant difference in the HHS of patients with HO between the DAA and DLA groups. There was no association between poorer clinical outcomes and the severity of HO.ConclusionThe DAA without a dedicated orthopaedic table is associated with a significant lower incidence of HO than the DLA 6 months after elective THA. Except for the surgical approach, no other factors correlated with the occurrence of HO. Even though a lower HHS was found with severe HO, the correlation between severity of HO and clinical outcomes did not reach statistical significance.© 2024. The Author(s).

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